Table 2 –

Selected Examples of Nursing Leadership in Genomic Nursing Health Care Policy and Translation of Precision Health into Clinical Settings

Example	Setting and Intervention
Curriculum and Nursing Education Standards
Doctoral nursing research	Creation of knowledge content areas needed for nursing scientists to perform omics research in health and disease states, and the fundamental core science areas required in undergraduate and graduate level nursing curricula (Regan et al., 2018).
Advance practice	Creation of essential genetic and genomics competencies for nurses with graduate degrees (Greco et al., 2011).
Baccalaureate	Establishment of the outcome indicators for essential nursing competencies and curricular guidelines for genetics and genomics (Calzone et al., 2011).
Nursing informatics	Developed recommendations for genetic and genomic competencies for nursing informatics internationally (McCormick & Calzone, 2017).
G2NA	Creation of the “Global Genomics Nursing Alliance” (G2NA) for the development of genomic competency education resources for the international community (Calzone et al., 2018c).
MINC	Development of “Method for Introducing a New Competency in Genomics,” a freely available patient care integration toolkit for hospital administrators and clinician educators at all levels of genomic competency (NHGRI, 2017).
Ethics, ELSI, and policy	Translation of the 2015 American Nurses Association Code of Ethics for Nurses with Interpretive Statements (Code) within the context of genetics and genomics by the Members of the Ethics and Public Policy Committee of the International Society of Nurses in Genetics (ISONG, Tluczek et al, 2018).
	Application of Ethical Legal Social Implications (ELSI) framework for genomics for the improvement of cancer care outcomes (Hammer, 2019).
	Nurse led recommendation to strengthen federal regulation of laboratory-developed and direct-to-consumer (DTC) genetic testing (Starkweather et al, 2018b).
Family history	Implementation of a pilot project in which nurses will obtain three-generation family health histories from 100 NIH Clinical Center patients in a sickle cell clinical trial followed by documentation and integration of the patient’s family pedigree into the electronic health record (Davis, 2019).
Hereditary cancer screening and oncology	Clinical overview for nurses of genetics and genetic tests in the clinical setting for identification of common single gene disorders such as hereditary cancer (breast/ovarian cancers, Lynch syndrome, others), nursing practice models, making appropriate referrals for genetic consultation and testing, providing patient education and family support to understand genetic test results and types of genetic testing technologies, provision of psychosocial support for family in the event of a positive or indeterminate genetic test, and to facilitate patient and family compliance with screening and treatment recommendations (Beamer, 2019; Eggert, 2017; Kelly, 2017; Montgomery et al., 2017).
	Comprehensive review of genomics knowledge integration into clinical practice for oncology nursing (Aiello, 2017) and next generation sequencing, multi-gene panel testing for in oncology settings (Kelly, 2017).
	Overview of clinical implications for advance practice nurses in hereditary breast and ovarian cancers, Lynch syndrome detection (Williams et al., 2016).
Multifactorial condition risks	Clinical overview for nurses of the genetic red flags in the detection of patient risks for higher risk of developing multifactorial conditions (those with combination of genetic and environmental factors) that have strong genetic components including: hypertension, hypercholesterolemia, coronary artery disease, stroke, autoimmune disease disorders, Alzheimer’s and Parkinson’s, and mental health disorders (Montgomery et al., 2017).
	Clinical overview of familial hypercholesterolemia detection for advanced practice nurses (Williams et al., 2016).
Neonatal screening and maternal health care	Nurse led policy recommendation for federal newborn screening requirements to be required in all 52 states, including 34 core heritable disorders and the reporting of another 26 secondary heritable disorders (Starkweather et al., 2017).
	Developed policy translation framework for roles of nurses and nurse scientists in use of genome sequencing technologies for population screening in newborns (Taylor et al., 2017).
Pharmacogenetics/pharmacogenomics (PGx)	Relevant summary of pharmacogenomic literature for Registered Nurses and Advanced Practice Nurses, websites including Clinical Pharmacogenetics Implementation Consortium (CPIC) and PharmGKB, and additional expert professional resources for pharmacogenomics in clinical nursing practice (Cheek et al., 2015).
Professional nurse certification in genomics	The Nurse Portfolio Credentialing Commission (NPCC) offers genomic health care practice certification and credentials for baccalaureate degree nurses (Clinical Genomics Nurse or CGN) and advanced practice degree nurses (Advanced Clinical Genomics Nurse or ACGN), (ISONG, 2018).
Racial minority population inclusion	Development of community-based participatory research framework for Black African immigrant participation in genomics research and DNA biobanking (Buseh et al., 2013).
	Development of a clinical workforce survey instrument to assess multi-ethnic nurses’ knowledge and practice of genetics and genomics (Coleman et al, 2014).
	Application of the transdisciplinary ConNECT Framework principles (model for behavioral medicine science and practice) to precision health to achieve population health through emphasis of diversity inclusion and recruitment of underserved and vulnerable populations in nursing research and practice (Menon et al., 2019).
	Outlined contributions of nurse scientists in -omics based research to facilitate policy development for precision health in minority populations. Developed recommendations for improving diversity among nurse scientists, educators, study participants, and continuing education programs (Taylor & Mendoza, 2018).
Symptom science	Defined use of symptom science and precision health in nursing research to further the understanding of patient symptoms and their self-management, including: omics requirements, data science infrastructure, research collaborations, analytical standards and controls, data workflows, data sharing and institutional policies, common data elements, and common data models for data integration (Cashion & Grady, 2015; Hickey et al., 2019).
	Developed standardization of self-reported adverse event reporting into clinically meaningful grading metrics for pediatric patient-reported outcome symptoms across nine pediatric hospitals (McFatrich et al., 2020).
Quality and patient safety	Nurse led policy recommendation to advance precision health implementation and nurses’ impact on health care quality and safety (Starkweather et al., 2018a).
Workforce development	Implemented a 12-month genomic competency pilot project for 8,150 hospital nurses in 23 Magnet facilities (21 intervention, 2 control). Intervention: hospital administrator-education dyads who received genomic training and resources followed by monthly supplementation and peer support to facilitate progress on institution-specific action plans. Outcome assessment: Genetic-Genomic Nursing Practice Survey data scores (Calzone et al., 2018a).
	Development of required nursing education during new-hire employee onboarding for all nurses who provide direct patient care: Introduction to Genetics and Genomics in Health Care (Cusack & Feigenbaum, 2016; NIH Clinical Center Nursing Department, 2020a).
	Development of intermediate nursing education for advanced concepts for NIH Clinical Center clinical research nurses and research nurse coordinators who directly care for patients (Cusack & Feigenbaum, 2016; NIH Clinical Center Nursing Department, 2020b).